Provider Demographics
NPI:1346055159
Name:ANDRADE, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 GRIGGS ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2572
Mailing Address - Country:US
Mailing Address - Phone:269-308-0084
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE ST STE LL56
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1034
Practice Address - Country:US
Practice Address - Phone:404-631-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant